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IPAP > Cardio 1-2 Summary > Flashcards

Cardio 1-2 Summary Flashcards

1
Q

NYHA Classifiction

A

1- No Sxs w/ ordinary activity (ACEI/ARB)
2- Ordinary activity causes Sxs (Loop, Thiazides)
3- less than ordinary activities causes Sxs (Ald Antagonist, Entresto)
4- Sxs at rest (Digoxine, Dobutamine)

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2
Q

Define Pulsus Paradoxus

What conditions can cause it?

A

Inspiration causes SBP to dec >10mmHg

COST of COPD
C. Pericarditis
Obstructive airway
SVCava obstruction
Tamponade
COPD
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3
Q

Criteria for OHOTN

What part of the criteria is most specific

A

Dec of HR by 30, SBP by 20, DBP by 10

HR- indicates low circulating volume

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4
Q

Define Osler’s Sign

Wide PP can be due to ?

Narrow PP can be due to ?

A

Calcified radial artery causes artificially high BP

AR
MR, MS, AS

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5
Q

Define Pulsus Alternans

Define Pulsus Parvus et Tardus

A

Changing PP amplitude due to LV dysfunction

Severe AS causing slow carotid upstroke

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6
Q

Define Pulsus Bisferiens

Define Spike and Dome pulse

A

Double wave from AS and AR

Double carotid pulse from HOCM

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7
Q

Normal boundaries and size for PMI

Normal duration of precordial palpitation?

A

5th ICS 10cm or less from midline, diameter 2-3cm

<1/2 of systole

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8
Q

What causes a loud S1

What causes a soft S1

A

Loud: THE Short PR
Tachycardia, High LA Press/CO, Early MS, Short PR

Soft: 1MC LH
1* Block, MR, Calcified MV, Late MS, High LV diastolic pressure,

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9
Q

What causes an S1 to vary in volume

What causes loud S2?
What causes soft S2?

A

VAC
Complete AV Block, V-tach, A-Fib

Soft: AS, PS
Loud: HTN, PHTN

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10
Q

What 4 issues can cause soft heart sounds?

What causes high pitched diastolic murmurs?
What causes low pitched diastolic murmurs?

A

POLE
Pulmonary effusion, Obese, Low CO, Emphysema

High: AR, PR
Low: MS, TS

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11
Q

What are the 6 parts of the JVP wave and what do they mean?

A

A wave: Atrial contraction
X descent: Atrial relaxation
C wave: TB bulge during RV systole, timed w/ carotid
X Prime: Heart base descent during ventricular systole
V wave: Passive atria filling against closed AV valve
Y descent: Early rapid atrial emptying

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12
Q

Lack of A-waves mean ?

Giant A-wave means ?

A

A-Fib, atrial stand still

Contacting atria against increased resistance
RVH, PS, TS, PHTN

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13
Q

Cannon A-waves mean ?

C-V waves mean ?

A

Contracting Atria against closed TV
AV dissociation, PVCs

Systolic venous pulsations
Regurgitating blood back into venous system in TR, makes a rapid y-wave

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14
Q

What does a sharp Y-descent mean?

Each small box on an EKG means ?
Each large box means ?

A

Constrictive pericarditis
Y > X phenomenon

  1. 04sec
  2. 2sec
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15
Q

EKG axis points ? hypertrophy and ? from infarcts

Normal axis range is -

A

Towards, Away

-30aVL - +30aVF

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16
Q

RVH criteria

LVH criteria

A

Must have RAD
No BBB
Dominant R in V1, dominant S in V5,6

Scott: Deepest S in V1,2 + deepest R in V5,6

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17
Q

RAE criteria

LAE criteria

A

P Pulmonale
R: P-wave >2.5mm in 2, 3, aVF

P Mitrale
L: P-wave >0.11s in 1, 2, aVL, V4-6 or,
Biphasic P-wave in V1

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18
Q

Where are Q waves normally present and where are they considered non-significant

What does the RCA supply blood to?

A

Normal in I, non-significant in III

2, 3, aVF
Inf/Post LV
RA/RV
Post 1/3 of septum
70% of SA nodes
85% of PDAs
AV node
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19
Q

What does the LAD supply?

What does the LCX supply?

A

V1-4
Ant 2/3 of septum
Bundle Branches
Bulk of LV/Ant surface

1, aVL, V5-6
25% of SA nodes
Lat/Post LV
LA
10% of PDA
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20
Q

What EKG changes are seen in Hyperkalemia

What EKG changes are seen in Hypokalemia

A

P FLEW
Peaked T, Flat P, Long PR, Elevated ST, Wide QRS

Flat UPS
Flat T, U wave, Prolonged QT, ST depression

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21
Q

What are the criteria for low voltage EKGs?

What are 3 drugs that can cause Prolonged QT and U waves?

A

Precordial leads <10mm
Limb leads <5mm

Quinidine, Phenothiazine, TCAs

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22
Q

How do PEs manifest on EKGs?

What is the purpose of using Holter Monitors

A

S1Q3T3
Pos aVR and V1

Detect arrhythmias
Relate Sxs to dysarrhythmia
Detect MIs

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23
Q

What does the Colour Flow on US assess for

TEEs are more sensitive and better for looking for ?

A

Valve regurgitation
Valve stenosis
Shunts

PEVD
Prosthetic heart valves, Emboli, Vegetations, IE, Dissection

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24
Q

Coronary angiography is the Gold Standard for ?, prognosis for ? and guiding therapy for ?

What information is provided by doing this procedure?

A

Detection/quantifying CAD
Post-MI
CABG vs PTCA vs medical therapy

Hemodynamics, Coronary anatomy, LVEF,

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25
Q

What drugs are used in pharmaceutical stress tests?

A

Inc coronary flow: Dipyridamole, Adenosine

Inc myocardial O2: Dobutamine (B1 selective)

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26
Q

What can cause sinus brady?

A 
Inc HIDE
Excessive vagal tone
Inferior MI
Drugs
Hypothyroid
Inc ICP
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27
Q

1* Block

2* Block M Type 2

2* Block W Type 1

3* Block

A

PR interval >0.2sec

Fixed PR and dropped QRS

Progressively longer PR until dropped QRS

No P-wave to QRS

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28
Q

Define Stokes-Adams attack

Criteria for RBBB

Criteria for LBBB

A

Syncope associated w/ brief cardiac arrest due to 3* block

Rabbit ears V1 and V2
Broad/notched R wave in V6 and aVL

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29
Q

Anterior Hemiblock criteria

Posterior Hemiblock criteria

A

A: LAD >45*
Small Q in 1 and aVL
Small R in 2, 3, aVF

P: RAD >110*
Small R in 1 and aVL
Small Q in 2, 3, and aVF

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30
Q

Tachycardia is greater than ?BPM and treated with ?

How are premature beats (atrial or junctional) treated?

A

100
Sxs= propanolol

BBs or CCBs

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31
Q

A-FIb beats at _BPM and is treated ?

A 
250-350
Valsalva, Adenosine 6mg, Adenosine 12mg
Rate control w/ BB, Verapamil, Digoxin
Rx Conversion: procainamide, Sotalol, Amiodarone, Quinidine
Electrical conversion: DC shock w/ 50J
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32
Q

Narrow complex tachy at 150bpm is ? until proven otherwise

MAT beats at ?BPM and is Tx w/ ?

A

A-flutter w/ 2:1 block

100-200bpm
Metoprolol

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33
Q

Define Ashman Phenomenon

A

Wide QRS’ after a long short R-R cycle and a Long R-R cycle in A-Fib

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34
Q

How is A-Fib rate controlled?

What is used for anticoagulant in paroxysmal or chronic A-Fib?

A

BB, Verapamil, Digoxin

Warfarin

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35
Q

What meds are used for A-Fib cardioversion?

A

Class I agent if ventricular function is normal- Procan, Propaf
Sotalol
Amiodarone
Synch’d conversion w/ Diltiazem

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36
Q

How are PSVTs treated?

How are Symptomatic PVCs treated?

A

Valsalva, Adenosine, Metoprolol, Digoxin, Verapamil
Chronic= BB, Verapamil, Digoxin, ablation

BBs

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37
Q

What is the most common underlying cause of V-tach?

When is an arrhythmia called VT and when is it an emergency?

A

CAD w/ MI

3 or more consecutive PVCs for more than 30seconds

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38
Q

What arrhythmia is most frequently encountered by adults who experience sudden death?

What class 1 and 3 drugs, two other classes can cause Torsades?

A

V-Fib

1- Quinidine
3- Sotalol
TCAs, Erythromycin

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39
Q

WPW EKG triad

What drug needs to be avoided and which one is used?

A

Tall R w/ Delta
Short PR
Long QRS

Avoid Digoxin (AV conduction slowing)
Use IV procainimide
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40
Q

What is the commonest cause of CV morbidity and mortality?

What are the two most important pathogenetic mechanisms?

A

Ischemic heart dz

Atherosclerosis and Thrombosis

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41
Q

What are 5 major risk factors for atherosclerosis heart Dz?

A

Smoking, DM, HTN, FamHx, Hyperlipidemia

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42
Q

JNC8 HTN Guidelines

AHA Guidelines

A 
Normal= <120 AND <80
Pre= 120-139/80-89
1= 140-159/90-99
2= 160 or more / 100 or more
Norm= <120 and <80
Elevated= 120-129 and <180
1= 130-139/80-89
2= 140 or higher / 90 or higher
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43
Q

What are the first and second most common causes of Secondary HTN?

How do you screen for HTN from Primary aldosteronism, Cushings, thyroid or hyperparathyroidism?

A 
1st= CKD
2nd= Primary aldosteronism
Thyroid= TSH
Hyperpara= PTH and Ca
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44
Q

What is the most common form of secondary HTN?

Define Fibromuscular Dysplasia

A

Renal Parenchyma

Condition causing stenosis and aneurysms of medium sized arteries in body, most commonly kidneys and brain

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45
Q

What type of pharmaceutical addition results is indicative of a sign for potential bilateral renal artery stenosis

ACEIs inhibit ? into ?
ARBs inhibit ? into ?

A

Rising creatinine after starting ACEI

ACEI- angiotensin 1 into 2 and bradykinin into fragments
ARB- angiotensin 2 into AT1 receptors

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46
Q

What is the triad of Pheo?

Familial Pheo may be associated with ?

A

Episodic HA, Sweating, Tachy
1/2 will have paroxysmal HTN

Multiple Endocrine Neoplasia syndrome type 2A/2B

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47
Q

What is the most reliable diagnostic test for Pheo?

How does hyperaldosteronism cause Secondary HTN?

A

24hr urine catecholamine and metanephrines

Excessive aldosterone from:
Conn Syndrome (adrenal adenoma)
Bilateral hyperplasia (primary hyperaldosterone)
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48
Q

What causes Secondary Hyperaldosteronism?

What is the classic finding in hyperaldosteronism and how is it Dx’d?

A

Rare renin secreting tumor

Unprovoked hyperkalemia
24hr urine aldosterone test w/ aldosterone:renin >25:1

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49
Q

What are the lab results for primary hyperaldosteronism?

What PE results may be seen?

A

Hypokalemia

Chovstek sign
Trousseaus sing

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50
Q

Define Cushing’s Syndrome

Define Cushing’s Disease

A

Synd= Excess cortisol causing increased blood volume and renin production

Dz= pituitary adenoma that over produces ACTH

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51
Q

How is Cushing’s Dx’d?

What are the 4 causes of Cushing’s Syndrome?

A

Dexamethasone suppression test
24hr urine cortisol levels

Adrenal hyperplasia/adenoma/CA
Oral steroids

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52
Q

What are the classic associations of hyperthyroid and hypothyroid?

Hyperparathyroid is commonly due to ? and characterized by ?

A 
Hyper= systolic HTN
Hypo= diastolic HTN

PTH secreting adenoma
Hypercalcemia

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53
Q

What medications have been linked w/ causing HTN?

How much alcohol intake has been associated with reducing CV morbidity and mortality

A

Estrogen, CCS, Cyclosporine, Erythropoietin, Pseudophedrine (OTC cold meds)

2 drinks or less per day

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54
Q

What is the appropriate way to document BP measurements?

When do results need to be confirmed on the contralateral arm?

A

Pressure, PT position, which arm and cuff size

+65, DM, Anti-HTN drugs

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55
Q

What is the next step if PTs BP readings are high and PT is under 30y/o?

When is ambulatory BP monitoring needed?

A

Take pressure on leg

White coat HTN and no end organ damage
Episodic HTN
HTN Sxs while on anti-HTN meds

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56
Q

The absence of a PTs BP decreasing by 10-20% during sleep is indicative of ?

When are annual BP screenings recommended?

A

CVD risk

40 and older w/ inc risk (130135/85-89)
Obese
Black

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57
Q

How often do PTs w/ BP under 130/85 and no risk factors need screenings?

How often do PTs between 3-17y/o need BP screenings?

A

Q3-5yrs

Annually

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58
Q

What test order is considered a standard part of the uncomplicated HTN work up?

What are the 5 non-pharm steps that can be taken to reduce BP

A

Chest x-ray

Weight= 5-20 dec
DASH diet= 8-14 dec
Na restriction
Exercise
Moderation of alcohol
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59
Q

What needs to be monitored when using Thiazides, Loops, ACEIs, ARBS or Alaskerine for HTN?

What lab test is used to monitor these?

A 
Thiazide= low K and Na
Loop= low K and Mg
ACEI= hyper K
ARB= hyper K
Allask= hyper K

BMP, Chem 7

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60
Q

What drug classes can not be used for HTN in pregnancy?

What two are used in post-MIs?

A

ACEI/ARB

BB, ACEI

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61
Q

What drug can be added to the 3 pregnancy anti-HTN meds to prevent reflex tachy?

What two meds are reserved for HTN Tx for PTs who fail everything else?

A

Hydralazine

Hydralazine
Minoxidil

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62
Q

Define/Criteria for HTN Urgency

A

> 180/>120 and no end organ damage
Reduce BP over 24-48hrs
Sxs= HA, SoB, Epistaxis, Anxiety

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63
Q

Define/Criteria for HTN Emergency

A

> 180/>120 and end organ damage

Stroke, LOC, Amnesia, Crushing chest pain, Eye/Kidney damage, Dissection, UA, Pulm Edema, Eclampsi

64
Q

What is the adverse effect if HTN urgency/emergency PTs have their BP decrease too much too soon?

Drugs used in HTN Urgency?

A

Worsening end organ ischemia

Clonidine
Captopril- use instead of Clonidine in HF
Labetalol- pregnant PTs or can’t tolerate Methyldopa

65
Q

What is the most commonly used ED parenteral anti-HTN med?

What type of HTN can it NOT be used for?

A

Labetalol

Cocaine intox and Systolic dysfunction w/ Decomp’d HF

66
Q

BP reduction goals for HTN Emergency

A

Compelling (Eclampsia, Pheo)- reduced to less than 140mm in first hour, (Dissection)- reduced to under 120mm

No compelling- reduce SBP no more than 25% in first hour, 160 in 4-6hrs and normal within 24-48hrs

Use of parenteral drugs is preferred

67
Q

What drugs are used for HTN Emergency caused by cocaine?

What drugs are used for HTN Pulmonary Edema

A

IV Lorazepam/Diazepam

IV Nitro (first line)
IV Nicardipine (favorable for systolic dysfunction and pregnant PTs w/ pre-eclampsia)
68
Q

What drugs are used in acute MI induced HTN emergency?

A 
IV Nitro (first line)
IV Metoprolol
69
Q

Adverse effects, C/I and Caution of using Sodium Nitroprusside

A

Cyanide toxicity, Methemoglobinemia
C/i- renal/hepatic failure
Caution- Inc ICP

70
Q

Adverse effects and Caution of using Nitro

A

Tachyphylaxis, Methemglobinemia

Caution- Inc ICP

71
Q

Adverse effects and Caution of using Hydralazine

A

Reflex tachycardia, HA

Caution: Angina/MI, Inc ICP, Dissections

72
Q

Adverse effects and C/I of using Enalaprilat

A

Hyperkalemia, Renal insufficiency

C/i- Pregnancy, Renal stenosis, Angioedema

73
Q

Adverse effects and Caution of using Nicardipine

A

Reflex tachy, N/V, HA

Caution- Angina/MI, HF

74
Q

Adverse effects and Caution of using Esmolol or Labetalol

A

Bronchospasm, HF exacerbation, Bradycardia

Caution- Acute HF, Asthma, Heart Block

75
Q

Definitive Tx for AVRT is ablation, what meds can be used for management and refractory cases?

A

Manage= BB, Diltiazem, Cerapamil

Refractory= Flecainide, Propafenone

76
Q

What ABX can’t be used as monotherapy for endocarditis?

What 3 drugs can be used prior to PCI as an anti-thrombolic, reduces morbidity and reduces bleed risks?

A

Gentamicin, must be used in combo

ASA, Bivalirudin, Ticagrelor

77
Q

What are the three ADP receptor inhibitor drugs used for anti-platelet therapy?

What drugs are first ling options for HTN Emergencies?

A

Clopidogrel, Ticagrelor, Prasugrel

IV Labetolol- a/b blocker
Nitroprusside
Nicardipine
Urapidil- blocks peripheral a1 receptors)

78
Q

How are PTs that are admitted for HTN emergencies weaned down and prepared for discharge?

What drug can be used for HTN emergencies in pregnancy that is given IV?

A

PO Labetalol
PO DHP CCB
IV Furosemide

Nicardipine

79
Q

What are the key findings to hint a PT has Fibromuscluar Dysplasia?

What is the other main cause of renal artery stenosis?

A

Renal and Abdominal bruits

Atherosclerosis in older PTs

80
Q

What medication can be used in systolic HF and reduces mortality and prevents hypokalemia?

Once this class of drug has started use, how long is it used for?

A

Eplerenone

Mineral corticoid receptor antagonists are used indefinitely

81
Q

When is a Pheo Dx highly indicative?

These are commonly mis-Dx as ?

A

HTN that is resistant to meds or paroxysms of HA, palpitations, pallor or diaphoresis

Panic D/os

82
Q

PT w/ systolic CHF can be given what med to improve Sxs and reduce long term mortality?

What can be given if the PT has diastolic CHF and still provide Sx reduction and improve mortality?

A

Carvedilol

Spironolactone

83
Q

What are Event Monitors AKA and when are they used?

A

Loop recorders

Record intermittent episodes during long periods (weeks to months), useful for patients with less frequent symptoms

84
Q

What is the primary indicator a PT needs an ICD?

What drug class is the first line therapy for managing angina and HF from exercise induced ischemia?

A

Sustained VT/VF in PTs w/ organic heart dz

BBs- Metoprolol

85
Q

PTs taking Warfarin are more likely to start spontaneous bleeding when INR moves in ? direction?

What is the difference in ANP and BNP?

A

Increases

ANP- stimulated from stretch, no reduction in PL/AL

BNP- reduces PL, AL and signals for diuresis
Used for Dx

86
Q

What are 2 conditions that can cause BNP levels to decrease?

What can cause levels to increase?

A

Obesity
Constrictive pericarditis

Age
Renal Dz

87
Q

African American PTs w/ HTN that have reduced GFR are given ? class drugs for Tx?

What is the next DOC for PTs with A-Fib and are unresponsive to BBs?

A

ACEIs

Digoxin

88
Q

What aortic issue is associated w/ Quincke sign and the head bob?

What are the 3 c/i for giving an ACEI in early ASx systolic HF?

A

AR

Hx of edema
HOTN
Bilateral renal stenosis

89
Q

What are the DOC for treating acute MAT?

What Tx is avoided?

A

IV Diltiazem, Verapamil or Metoprolol

Conversion

90
Q

What drugs are used for anticoagulation therapy before/after conversion for A-Fib?

What heart issue can develop from the last month of pregnancy to 5mon post-delivery?

A

Dabigatran, Rivaroxaban, Apixaban, or Endoxaban, or Warfarin with an INR of at least 2

Peripartum cardiomyopathy

91
Q

How is peripartum cardiomyopathy treated?

What is the most common cause of HF w/ preserved EF?

A

Furosemide
Sulfa allergy= Ethacrynic acid

HTN

92
Q

What are 3 conditions that can cause high output HF?

What microbe causes myocarditis?

A

Obesity, Anemia, Renal Dz

Coxackie B Virus

93
Q

What rhythm is associated with alcohol induced dilated cardiomyopahthy?

A second murmur can develop with AR and exist with what other murmur/cardiac issue?

A

A-Fib

Austin Flint- MV rumble heard at LV apex

94
Q

What drug classes are used for CKD PTs w/ HTN?

What can be used for Diabetics w/ HTN?

A

ACEI/ARB

AACT

95
Q

What drugs are first line agents for rate control in non-HOTN A-Fib?

What drug is third in line?

A

Esmolol, Metoprolol, Verapamil, Diltiazem

Digoxin

96
Q

PT w/ new onset A-Fib are considered good candidates for conversion and are anti-coagulated with ? drugs?

A

Direct acting PO anti-coags

dabigatran, rivaroxaban, apixaban, or edoxaban

97
Q

WPW A-Fib is Tx w/?

WPW wide complex is treated w/ ?

A

Ibutalide

Procainamide

98
Q

IE microbe if on native valve, IVDA, Colon CA, Prosthetic valve?

The LMNOP algorithm is for what two Tx?

A

Native: Strep V
IVDA: Staph A
Colon CA: Strep Bovis
Prosthetic: Staph Epidermis

Decomp HF
Pulmonary edema

99
Q

Define Diastolic Dysfunction

Define Systolic Dysfunction

A

Dec end diastolic volume, ineffective ventricular filling

Ineffective ventricular emptying

100
Q

HFrEF

HFpEF

What is the ‘pure form’ of HF?

A

Systolic dysfuntion

Dystolic dysfunction

R sided

101
Q

Define Preload

Define Afterload

Define Contractility

A

Wall tension at diastole end

Wall tension during contraction

Property of heart muscle that accounts for strength of contraction and independent of AL/PL

102
Q

Reduced EF= _%

Gray zone= _%

Preserved EF= _%

A

<40%

40-50%

> 50%

103
Q

S/Sxs of HF w/ reduced EF

A

Dyspnea, Paroxysmal, Nocturnal
Dilated LV
Elevated LV filling pressure
Primary systolic dysfunction

104
Q

What are the 3 parts that contribute to HF?

A

Impaired contractility (HTN,AS)
Inc AL
Impaired ventricle relaxation/filling- vol overlaod, AR, MR, DCM

105
Q

Once cardiac remodeling has occurred, there is ? which triggers what 3 systems which all lead to what end result?

A

Dec EF

RAAS, Adrenergic and Hypothalamic neuro-hypophyseal systems

Inc water retention and plasma volume

106
Q

HFrEF hypertrophy can lead to the development of ? murmur?

A

2nd MR

107
Q

What is the LMNOP of decomp HF?

What drug is used for PTs in decomp HF and which one is never used??

A

Lasix, Morphine, Nitrates, O2, Position (not supine)

Dobutamine
Never use BBs

108
Q

What would be two c/i for giving CCBs?

How long after starting a diuretic or an ACEI does monitoring need to occur for potassium levels?

A

Edema, Constipation

Diuretic- 4-6wks
ACEI- 1wk

109
Q

What is the TIMI score used for and how is it calculated?

A 
65 or older
3 or more CAD risk factors (FamHx of CAD, HTN, Hyper cholesterol, Diabetes, Smoker)
CAD/Stenosis 50% or more
ASA use in past 7 days
2 or more angina episodes in past 24hrs
ST segment changes 0.5mm or more
Pos cardiac markers

0-2 Low
3-4 Mod
5 or higher High risk of 14 day mortality, New/Recurrent MI or severe recurrent ischemia requiring revascularization

110
Q

What regurgitation can happen with HCM?

What type of microbe can cause endocarditis from poor dental hygiene?

A

MR

Step viridians

111
Q

What 3 Sxs can be classified as a symptom of HTN emergency?

Pulsus alternans is a common Sxs from what type of HF?

A

Chest pain, Dyspnea, Neuro deficits

L ventricular systolic HF

112
Q

What is the gold standard for Dx myocarditis?

How do atypical MIs present?

A

Endomyocardial biopsy

Older, Female, DM, HTN, Post-heart transplant

113
Q

Aortic root dilation is usually associated with ? congenital d/o and type of valve?

Failure to carry out conversion properly can lead to the development of ? arrhythmia?

A

Turners, Bicuspid

V-Fib

114
Q

How does nitroprusside work?

ANP released by increased stretch is associated with what two results?

A

Arterial and venous dilator by increased cyclic GMP that activates Ca sensitive K channels in membranes

Increased vascular permeability
Rapid fluid shift into interstitial space

115
Q

What labs need to be drawn prior to starting PTs on statins?

AS in young PTs mean ?
AS in older PTs means?

A

LFTs

Calcified bicuspid
Calcified tril-eaflet aorta

116
Q

What is Digoxin’s MOA?

What effect does it exert?

What are the s/e?

A

Inhibits Na/K/ATPase

Dec AV conduction and contractility

N/V/D
Yellow vision

117
Q

What is the most serious reaction that can come out of Amiodarone use?

Hemodynamically unstable bradycardia in a PT with a recent Hx of viral illness can be due to ?

How is it Tx?

A

Interstitial lung Dz- SoB, dry cough, R sided HF

Myocarditis

Inc HR w/ inotropic support/pacing

118
Q

What can PAOP measurements be used to determine?

What is the most common cause of non-ischemic cardiomyopathy in Latin America?

A

LV failure, MS, pathologies that inc LA pressure

Chagas myocarditis

119
Q

What drug class is the DOC for PTs w/ HTN, DM or Microalbuminemia

What are 3 ends results of Rheumatic heart Dz?

A

ACEI

MS, A-Fib, Pulmonary Edema

120
Q

What movements increase and decreases HOCM?

What microbe causes acute Rheumatic Fever?

A

Valsalva and Standing
Dec w/ squatting

GAS- Strep Pyogenes

121
Q

What are two potential complications that can arise post-MI?

Mesenteric ischemia is similar to ?

A

VSD from septal rupture
MR
Free wall rupture turning into tamponade

Atherosclerosis of stable angina

122
Q

What are the water shed areas affected by mesenteric ischemia and what arteries supply them?

What is the most common cause of sudden cardiac death after MIs?

A

Splenic flexure- superior mesenteric artery
Rectosigmoid junction- inferior meseneric artery

Ventricular arrhythmia

123
Q

Viral myocarditis can lead to ? and presenting as ?

Define Cor Pulmonale

A

DCM, dec systolic function and chamber dilation

Severe lung Dz elevated pulmonary artery pressure pushes back to the RV and causes failure

124
Q

What are five causes of DCM?

How does the atherosclerosis process begin?

A

Alcohol, Pregnancy, Coxsackie, Idiopathic, Genetic

Lipids and inflammation accumulation causes turbulent flows and intimal damage

125
Q

? is an indication for renal artery stenting?

What drug class can be given to ASx or Sx LV systolic dysfunction and reduce mortality and hospitalization?

A

CHF

ACEI

126
Q

What microbe is associated with endocarditis and colonic neoplasm?

What is the DOC given to all PTs w/ systolic HF?

A

S Bovis biotype

ACIE and BB w/ Metoprolol Succinate the DOC

127
Q

Define Conn Syndrome

How does it present?

A

Common cause of Secondary HTN

HTN, hypokalemia, metabolic alkalosis

128
Q

What are the two Sxs of HCM that present if death isn’t first?

How do NSAIDs worsen HF?

A

Dyspnea and chest pain

Na retention
Negative ionotrope
Cardiotoxicity
Inc renal dysfunction
Impaired ACEI/Diuretics
129
Q

What are the major Framingham criteria?

What are the minor Framingham criteria?

A

RN PATCH
Rales, Neck vein distension, Paroxysmal dyspnea, Acute pulm edema, Third heart sound, Cardiomegaly, Hepatojugular reflex

HaD PANTs
Hepatomegaly, Dyspnea w/ exertion, Pleural effusion, Ankle edema, Nocturnal cough, Tachy +120

HF Dx w/ 2 major or, 1 major and 2 minor

130
Q

What are the cardinal Sxs of HFrEF?

What’s the difference between Ecentric and Concentric hypertrophy?

A

Dypnea and Fatigue

Ec- inc ventricle chamber radius and thickness
Con- inc wall thickness w/out proportional dilation

131
Q

What does the HEART FAILED acronym stand for?

A 
Precipitating factors of HF
HTN
Endocarditis/environment (heat)
Anemia
Rheumatic/valve dz
Thyrotoxicosis
Failure to take meds
Arrhythmia
Infection/infarct
Lung problem
Endocrine (pheo, hyper aldost)
Dietary indeiscretion
132
Q

HFrEF ventricular hypertrophy and Remodeling occur due to ?

What are the 5 neuro-hormonal compensatory mechanisms of HFrEF?

A

Hypertrophy- press and vol overload
Remodel- eccentric and concentric remodel

Natriuretic peptides
Endothelin
Adrenergic nervous system
RAAS
ADH
133
Q

What are the 5 commonest causes of CHF?

A 
CAD
Idiopathic seen as DMC
Valve- AS, AR, MR
HTN
Alcohol as DMC
134
Q

What are the less common causes of CHF?

A

GEMTIPI
Genetic- Freidrichs ataxia, hereditary HCM
Endocrine- hyperthyroid, DM, acromegaly
Metabolic- thiamine/selenium deficiency
Toxic- adriamycin, doxorubin, radiation, uremia, cathchol
Infectious- Chaga, Coxsackie, HIV
Peripartum
Infiltrative- sarc/amyloidosis, hemochromatosis

135
Q

What are the two cardiac responses to myocardial stress?

What are the systemic responses to ineffective circulating volume?

A

Pressure overload leads to hypertrophy (HTN)
Volume overload leads to dilation (AR)

Activation of sympathetic NS and RAAS-
Na/H20 retention, Inc HR/contractility, Inc AL

136
Q

Long term CHF management steps

A

O2, Bed rest, Head elevation

1- Na/Fluid retention control w/ daily weights - Furosemide w/ or w/out Metalozone

2- Vasodialtor to inc PL and dec AL- ACEI, Hydralazine and Nitrates, Amlodipine (DCM), ARBs

3- Ionotropics- Digitalis (CHF w/ A-Fib)

4- BB (class 2-4), Carvedilol (Class 2-4), CCBs, Amiodarone (anti-arrhythmic DOC)

137
Q

What are the risk factors for DCM?

A 
CRIMINATED FIP
Collagen vascular dz
Radiation
Idiopathic
Metabolic
Infectious
Neuromuscular Dz
Alcohol
Toxic
Endocrine
Drugs- chemo/Adriamycin
Familial
Inflammatory
Peripartum
138
Q

What are the clinical manifestations of DCM?

What tests are done?

A

CHF, Systemic/Pulmonary Emobli, Arrhythmias, Sudden death

ECG, CXR, Echo, Endomyocardial biopsy, Angiography

139
Q

Endomyocardial biopsies can be used to Dx what 2 Dzs?

A

RCM, Myocarditisq

140
Q

How is DCM managed?

A

Treat CHF, BB, ACEI
Anti-coag w/ coumadin- absolute if A/Fib/embolus Hx or if EF <20%
Tx arrhythmias
Imms- Influenza and Pneumococcus
Surgery- transplant, LVAD, volume reduction surgery, cardiomyoplasty (latissimus dorsi wrap)

141
Q

What are the hallmark signs of HOCM?

A

Pulses- rapid upstroke, bifid pulse
Triple apical impulse
Normal/Paradoxically split S2
S4

142
Q

How investigatory tests are ordered for HOCM?

What is the most reliable risk factor?

A

EKG: Prominant Q waves or Tall R in V1
Echo
Cardiac cath

Survived cardiac arrest/Sustained VT

143
Q

What is the most common cause of restrictive cardiomyopaty?

How is it treated?

A

Amyloidosis

As CHF

144
Q

What is the most common microbe to cause IE in spontaneous bacterial endocarditis on an abnormal valve or MVP?

What causes IE, Group D Strep and Spontaneous Bacterial endocarditis?

A

Strep viridians

Entercoccus

145
Q

What microbe is usually R sided and catheter associated sepsis?

What microbe is most likely to infect a prosthetic valve?

A

Staph A

Staph epidermis

146
Q

What causes a high risk for IE in cardiac lesions?

What causes moderate risk for IE?

What is the frequency of valve involvement from IE?

A

Prosthetic valve, Previous IE, Congenital cyanotic dz, surgical pulmonary shunts

Congenital cardiac malformations, Acquired valve dysfunction, HCM, MVP w/ MR, Thick leaflets

MATP

147
Q

What microbe causes Rheumatic Fever and how does it present?

A

GAS that later effects MV

Lymphadenopathy, Fever, Sore throat

148
Q

What are the major/minor Jones criterias for Rheumatic Fever?

A

Major: Pancarditis, Polyarthritis, Sydenhams chorea, Erythema Marginatum, Subcutaneous nodules

Minor: Prev Hx of RF/RHDz, Polyarthralgia, Inc ESR/CROP, 1* Block, Fever plus

149
Q

AS management

When is surgery indicated

A

ASx= serial echo, avoid heavy exertion, IE prophylaxis,
Avoid nitrates, dilators and ACEIs

Angina, Syncope, CHF
Progressive LV dysfunction

AV replacement, Balloon valvuloplasty

150
Q

What drugs are used for AR to reduce AL?

What drugs can be used to treat CHF from AR?

A

Nifedipine, ACEI

Digoxin and diuretics

151
Q

When is surgery indicated for AR?

What surgical procedures are done for AR?

A

LV failure
LVEF <55% at rest or EF fails to inc w/ exercise

Replacement- Ross procedure
Reapire- rare, annuloplasty for annular dilation

152
Q

What are the 4 signs of chronic AR?

A

Pulses- DD CQT Hills (fem-brachial difference of >20mm
Precordial palpitation- having apex from volume overload
Precordial auscultation- soft S1/2, S3, Austin Flint, ejection
Acute AR- PTs present w/ CHF, Tachy, Soft S1, Soft/absent S2, Early diastolic murmur, preclosure of MV

153
Q

When is surgery mandatory for MS?

A

Closed commisurotomy
Balloon vavluloplasty based on TTE
Open commisurotomy- best
Repalcement- immobile leaflet, calcified, severe subvalvular dz, MR

154
Q

What signs will be seen in TS/TR?

A

Prominant A- TS
Larve V/CV waves- TR
Positive HJR and Kussmaul sign

155
Q

JVP waves for tamponade?

What is becks triad?

A

X descent only, Absent Y

HOTN, Inc JVP, Muffled heart sounds

IPAP (212 decks)

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